Photovoice is a qualitative participatory-action research method suitable for the needs and goals of public-health research and promotion. This method puts cameras in the hands of research participants, giving them a ‘voice’ to document their surroundings, empowering them to construct the knowledge and representations of their own environment and encouraging sharing and critical dialogue among the participants and their communities. Photovoice has significant advantages over other qualitative research methods in some circumstances, but its implementation in the field may require adaptation to adverse fieldwork conditions. This research project case describes the use of Photovoice during fieldwork for a medical sociology study accompanying a medical-humanitarian mission to an impoverished rural area of Nicaragua in 2009. This case explores the core facets of the methodology, discusses adaptations in the field, highlights some unexpected ethical issues and provides a self-evaluation of the successes and failures of these adaptations. The results will be of particular interest to researchers deploying Photovoice research in their fieldwork and to qualitative fieldworkers more generally.